For someone who teaches interdisciplinary groups of health
professionals about critical appraisal of research and its application
to clinical practice, the content of this textbook was immediately of
interest. Many clinicians tend to already have a good understanding of
general research design and knowledge about appraisal of individual
studies. What clinicians can be more uncertain about are issues such as
how to distinguish a good systematic review from a poor one, how to
appraise a meta-analysis, how to critically appraise a clinical
guideline, and how to review qualitative research. I approached this
textbook with a belief that in addition to being able to critically
appraise published evidence, clinicians also benefit from guidance
regarding how to actually apply evidence to clinical practice. I was
delighted to find that Hoffmann and colleagues have provided an
excellent resource for learning about and teaching about these, and
other, aspects of evidence based practice.

Chapter 12 covers in detail the differences between a systematic
review and a meta-analysis, between systematic reviews and narrative
reviews; what to expect from a good systematic review and the key
features of systematic review methods. This chapter also provides clear
guidance regarding how to read forest plots (to interpret results from a
meta-analysis) and how to apply information from a systematic review to
clinical practice.

Chapter 13 focuses entirely on clinical guidelines, providing
excellent advice about how to be an informed consumer of these
ubiquitous documents that have swamped the health sector in past few
decades. In my opinion, clinicians are not always as quick to question
the credibility of published clinical guidelines as they are of
individual research studies yet the quality of clinical guidelines can
vary widely. Chapter 13 provides information on how and where to find
clinical guidelines, how to evaluate the quality of a clinical guideline
(drawing heavily on that excellent resource, the AGREE instrument), and
on how to use a guideline in clinical practice.

Critical appraisal of qualitative research is covered in Chapter
10, which is entitled "Evidence about clients' experience and
concerns". This chapter provides information on what sorts of
research questions can be answered by qualitative studies and provides
an overview of the main qualitative methodologies that clinicians are
likely to come across in health science literature. It also provides a
framework for critical appraisal of qualitative research, basing this on
the Joanna Briggs Institute's Qualitative Assessment and Review
Instrument. There is, however, one aspect of qualitative research that I
would have liked to read more about in this text, that is the
application of qualitative metasynthesis (aka. systematic review methods
for qualitative research) to evidence based practice. Qualitative
metasynthesis is touched on very briefly in Chapter 12 in reference to
the potential value of combining qualitative and quantitative studies in
systematic reviews. However, mainly the authors point out that:
'There is still significant debate about whether a synthesis of
qualitative studies is appropriate and whether it is acceptable to
combine studies that use a variety of different methods' (p. 244).
While this is indeed true, qualitative metasynthesis is a fast growing
area of health science research. Many qualitative metasyntheses are
already published in peer-reviewed journals, so clinicians will need to
have some skills for reading and interpreting them. There are also an
increasing number of texts exploring the strength and weakness of
different approaches to qualitative metasynthesis, and some tentative
guidelines could still be provided regarding what should be expected of
a good qualitative metasynthesis.

Other chapters in this textbook address issues related to: asking
research questions (Chapter 2), finding best evidence (Chapter 3),
evaluating and applying evidence from research on the effects of
interventions (Chapter 4), diagnosis (Chapter 6) and prognosis of
outcomes (Chapter 8).

In terms of applying evidence to clinical practice; this is
achieved in a variety of ways. Examples of clinical scenarios are
provided throughout the chapters in this textbook where the need for
evidence is sought and required. Furthermore, a number of additional
chapters (Chapters 5, 7, 9, and 11) have been added after each major
section in the textbook to provide worked examples illustrating in
detail how this taught knowledge can be applied in clinical practice.
These examples are provided from the perspective of issues relevant to a
range of different health professionals (e.g. occupational therapy,
physiotherapy, podiatry, speech language therapy, radiation therapy,
dietetics, medicine, and nursing) so there should be something familiar
in these examples for everyone. Finally, two additional chapters are
included at the back of the textbook that discuss the relationship
between clinical reasoning and evidence-based practice (Chapter 15) and
how to implement evidence into practice, including the use of clinical
audit (Chapter 16).

Finally, there was one additional section in this textbook that I
was delighted to find--a chapter covering how to discuss with evidence
based practice with clients (Chapter 14). This chapter includes
information about how evidence-based practice fits with the
client-centred ideology and how to communicate effectively with patients
about evidence and evidence-based practice. There are a range of
communication methods that are promoted here, some of the most
interesting relating to how clinicians can best communicate complex
statistical information in a meaningful way with their clients.

All things considered, this textbook gets the thumbs up. I would
recommend this as a 'must-have' text for clinical departments
in hospitals and public health services where development of clinical
policies and procedures ought to be grounded in a strong understanding
of evidence based practice. Additionally it is an excellent resource for
health professionals undertaking study or research training at a
postgraduate level.